I have arthritis, should I exercise?

About 70% of people over the age of 65 will have some level of arthritis and 1 in 5 of the whole population. This equates to around 10 million people in the UK.

A number of people will have no symptoms and be oblivious to the fact that they have arthritis, but most people with it will suffer some symptoms, such as pain and stiffness, on a daily basis.

The most common type of arthritis is Osteoarthritis, followed by Rheumatoid (especially in women) and Gout (especially in men).

There are actually over 100 different diseases that can cause the problems characterised as arthritis.

There is no cure for arthritis.

What is arthritis?Arthritis affects the joints of the body. At least two bones meet to form a joint, but some joints have three and wrists and ankles have more. Each joint in the body is constructed in a slightly different way. Most of the main joints have cartilage covering the bone ends and the whole joint is enclosed in a sort of bag called the joint capsule. This bag holds synovial fluid which effectively lubricates the joint.Arthritis develops when the cartilage has become worn, torn, or has been removed, often due to trauma.The synovial fluid within the joint capsule becomes thicker or ‘stickier’ as we age and as a result doesn’t coat the cartilage as well. This results in increased wear to the cartilage and the bone ends which become roughened. The joint can no longer slide smoothly and pain results. This is typical in osteoarthritis of the knees, shoulders and hips.With Rheumatoid arthritis joints become swollen as the body attacks its own tissues. There are many other forms of arthritis, such as spondylitis which is when inflammation around the spine causes pain.

What causes arthritis?Arthritis has a variety of causes, most of which are not fully understood. For example:

Trauma to a joint earlier in life frequently makes arthritis more likely. A car accident, sporting injury, trip or fall can all cause damage to a joint, weakening it and making it susceptible to arthritis, sometimes not manifested until later life.

Cartilage has a poor blood supply which means that when damaged by twisting or tearing is doesn’t heal very well. As a result, it was common for cartilage to be removed following trauma, although nowadays this is less frequently performed and exercise is used to manage the situation.

Carrying excess weight puts more strain on the joints increasing the amount of wear and tear.

There is a clear genetic link which can increase the risk factor for Rheumatoid arthritis which can be activated by trauma.

Exercising with arthritis.Arthritis causes joints to be stiff, painful and to have a reduced range of movement. Exercise can improve these symptoms but it needs to take account of the arthritis. I work to create an environment and exercises within which the joints can be moved freely and without pain and you feel able to exercise within you own capabilities. In addition, exercise can encourage good posture, which is essential in keeping the spine straight and reducing the risk of kyphosis – rounding of the neck shoulders as well as potentially slowing the progress of degeneration.

Key points to remember:

Loosening joints, using movement which is pain free, is essential to encourage and keep the maximum mobility. For example, in ball and socket joints, simply rotating the limb within the joint capsule can have a beneficial effect, by encouraging the synovial fluid to coat the whole joint and become less ‘sticky’.

Specific muscle strengthening work to support the damaged joints will help reduce pain on a daily basis. This is especially beneficial for the hips, shoulders, knees and spine.

Do not push through the pain, look for a different way to loosen or strengthen the painful area.

Avoid overstretching and putting joints into positions out of their normal range. For example, knees are a hinge joint, designed to bend in a forward and backward motion with limited rotational range. Sitting with legs crossed will stress the joint and in time can cause wear and then damage.

Note which activities cause pain and look to find other ways of doing them. Exercise can be designed to help you strengthen your body enabling you to do regular activities with less pain.

Finally:Arthritis can be debilitating and has no cure, but exercise is one of the recommended treatments - don’t let arthritis be a reason to stop exercising.

Exercise - Benfits more than just your body!

When you think about ‘exercise’ you probably think about the benefit to your muscles and cardio vascular system, that it may hurt, you may ache afterwards but you’ll feel better for it and you’ll spend time with a group of likeminded people at your class or in the gym. The first few statements relate to the physical benefits, but the latter are the extra benefits you may not have considered as being so important.

NHS Choices has this to say about exercise and mental wellbeing:

“It has long been known that regular exercise is good for our physical health. It can reduce the risk of cancer, heart disease and strokes. In recent years, studies have shown that regular physical activity also has benefits for our mental health. Exercise can help people with depression and prevent them becoming depressed in the first place. Dr Alan Cohen, a GP with a special interest in mental health, says that when people get depressed or anxious, they often feel they're not in control of their lives. "Exercise gives them back control of their bodies and this is often the first step to feeling in control of other events," he says.”see : http://www.nhs.uk/conditions/stress-anxiety-depression/pages/exercise-for-depression.aspx for the full detail.

So, if you are feeling down, generally tired, depressed or lonely, why not try a regular exercise class?

If you’re not used to exercising particularly in a class, you may think of a number of reasons why exercise is not for you. Often, these reasons are based on misunderstanding or misinformation. I have listed a few common feelings here along with an explanation of what actually seems to happen.

I have never been sporty, so I don’t do physical activity.In fact many of our class members are not sporty in the slightest, and they still find the classes are easy to do.

I always feel tired so class will simply exhaust me further.Many exercises or movement in classes can be made easier or harder by the way you do them. Simply do as much or as little as you feel you can.

Exercise has to hurt to be beneficial, I don’t want that.The more recent thinking by exercise professionals is that “no pain, no gain” is not, in fact, true. In reality we have seen plenty of people who have improved their fitness and personal wellbeing, through exercise, and have not felt any pain in the process.

When I get there everyone will know everyone else, consequently I will be left out and feel awkward.Whilst some classes can be a bit insular, in our experience most class are actually very inclusive. New people are joining all the time and are very soon embraced by the class camaraderie. As an alternative why not take a friend with you?

I have tried yoga/pilates/circuits/whatever and I found it painful/just didn’t like it.Actually, pretty well every class is different in one way or another. The content is usually created by the person giving the class so there are as many different forms of pilates, yoga, circuits, boot camps, meditation, etc. as there are teachers. It is worth trying a number of different classes until you find the ones that suit you. Almost always there is at least one out there.

I have never done any exercise, there are so many different classes I don’t know where to start.In this case, go for pilates or yoga. Look for a class where the instructor tailors content to fit peoples’ ability. Talk to the instructor, or other class members to find out about other classes in your area that may suit you. Then just go along and give it a go. It is normally easy to have a trial at any class and move on until you find one you like. But it is always worth taking to the instructor about any aspect that you didn’t like because it may be that it could be change to suit you.

The fact of the matter is that almost everyone can benefit from joining a class.

If you continue to be inactive you are more likely to suffer from low mood, depression, tension, stress, anxiety and worry.

By taking more exercise you will feel better about yourself, be less depressed, less anxious, have improved sleep and better concentration, not only this, but you will improve your physically capabilities. All great reasons to be more active, particularly the older you get.

Looking at the technical side of why we benefit mentally from being more active there is a combination of reasons, some of which are not fully understood. The simplest factor is that exercise stimulates the release of mood enhancing chemicals, dopamine and serotonin. On top of that the social aspect of common goals and camaraderie have a positive effect, as does the realisation of achievement. Also your support network can be extended, we have found that classes are very good at support and often bring together common experiences and solutions to life’s difficulties.

The key to gaining a benefit is in finding an exercise programme which suits you.

It needs to be enjoyable and an escape from the pressure of ever day life.

It may not be hard work and you should feel able to rest during the class when you feel that you’ve done enough.

There may be a strong social element with interaction with others in the group. The companionship you feel from your fellow class mates can be as important as the actual exercise.

The training he will provide is varied and is planned to suit your individual needs and goals, whether you want to work on technique, become healthier, lose weight, improve your fitness or just learn something new.

So whatever you are aiming for, Macauley can help you reach your goals and achieve them faster than you would on your own.

Personal training sessions vary from person to person, areas that you may cover in a session include padwork, technical work, cardio and plyometrics. All equipment is provided and all you need to bring is lose fitting clothing, suitable for working out in. Nutritional advice is also available on request.

Why do you need strong 'glutes'?

When new people join a class or come to me with back pain they are usually completely unaware of their glute muscles. The glutes are quite likely to be weak and tight, which sounds like an odd combination.

Strengthening the muscle and stretching it so it can function correctly is an essential part of keeping your body working effectively and without pain.

Keeping correct alignmentStrong glutes can protect you from injury and reduce the impact of arthritic pain by providing support to the spine and pelvis. They also give correct alignment throughout the body helping to protect the knees from uneven wear, keep the feet lined up reducing problems with the achilles and plantar fascia.

Support when walking or running or weight trainingThe glute muscles stabilise your pelvis while you run or walk. They help with hip extension and forward propulsion. If they fail to engage correctly the work falls to the hip flexors which are less able and become tight quickly. This puts stress onto the lumbar spine giving back pain. Strong glutes help give correct positioning when weight training, especially during squats, so your knees are protected. They also help with protecting your back when bending to pick up items from the floor or gardening.

Injury preventionIf your glutes are not strong, your entire lower body alignment may become out of balance causing injuries such as achilles tendinitis, shin splints, knee pain and leading to tight ITB which runners are particularly susceptible to. When the glutes are not strong enough to do their job, other muscles not as well designed for the job take over. While in everyday life it is usually the back which suffers, in those who train at a higher level the muscle imbalance is more pronounced leading to increased risk of injury.

StrengthThe glutes are one of the largest muscle groups in the body. If trained it can produce an enormous amount of power. By strengthening this muscle you will be able to move with less stress on your skeletal structure. This is of enormous benefit as bones become less strong with age and affected by degenerative conditions.

Reduction in back painTo simplify the effect strong glutes have on back pain visualise your spine. It runs from the back of your head to your pelvis (hip bones). Your pelvis sits like a t junction at the bottom of your spine. Below this are your glutes, providing support to everything above it – hips and spine. Once you move they are powering from behind you enabling you to move easily with less effort. The other muscle groups, abdominals, quads and hip flexors are at the front of your body and while they are essential for movement and stability they are not nearly so well placed to provide power as the glutes.

How important is balance to your overall health and well being?

Many clients I see have very poor balance skills when they first attend The Studio. This usually improves hugely within a few weeks. I am frequently asked why it is that our balance is so bad, and, why it is important to improve it.

Firstly, why is our balance poor?Balance is a motor skill which we acquire in childhood. It requires the use of large muscles groups and although this skill remains with us throughout our lives it deteriorates with age. At any stage of your life it is possible to improve your balance skills with training.The ageing process causes muscle weakness which will affect the body's ability to recover from a trip on an uneven surface. With age often comes inner ear misbalance causing dizziness or blood pressure issues which can cause light-headedness. Also failing eyesight means you may mis-judge uneven surfaces, or distances from objects. All of these situations can easily lead to falls.

How big a problem is this?It is estimated that 30% of the over 65's fall every year, and more than half of the over 75's living in nursing homes or care facilities are unable to live independently because of falling.Women suffer from bone thinning (osteoporosis) and this increases the risk of hip fractures if they suffer a fall. Almost 50% of hip fractures are seen in people who had no mobility problems prior to their fall, however only 50% recovered to their previous level of mobility (NICE 2012)

How does this affect you?

Every time you walk you put all of your weight on your front foot as you lift the back foot up to swing it through. If you step on an uneven surface, ice or simply misjudge the height of a kerb you will need to be able to balance on one leg for that little bit longer than usual to avoid falling. This is particularly true when walking down steps.

When you reach up to a high shelf you probably balance on one leg to gain extra height.

When you get out on the car you will place one foot down and put your weight through that leg as you push up to standing. The added twist provides more challenge to the balance and it is easy to strain your back if your muscle structure doesn't support you too.

Things to remember

Balance can be improved with practise both in a controlled environment such as with an exercise therapist and at home.

Improved core strength gives better balance.

A fall can signal the end of independent living, changing your life completely.

Physical Therapists and Practitioners: which one is right for me?

There are a whole host of people out there offering a service to improve your physical being. Some have virtually no training, others have trained for years. Some provide a diagnosis, others just relieve stress. Some are very different, Pilates vs Indian head massage, while others are confusingly similar, osteopathy vs physiotherapy vs chiropractic. Some provide regular exercise, others are more remedial. So which one is right for you?

To look at it another way, for what should I go to each person? Or, what can I expect from each visit? Unfortunately, and possibly surprisingly there is not a straight forward answer to this (except possibly for GPs). Mainly because each therapy is practiced by an individual and your experience will vary greatly, even within a single discipline, depending on that individual’s experience, capabilities and beliefs. The best thing to do is book a consultation session so the practitioner can explain what services they offer, what you can expect to experience with them and a recommendation as to what would be best for you. Alternatively talk to someone who has been to a session and get a recommendation.

To help you choose which is right for you we can identify some basic information about each therapy.

1 Medically qualified and registered practitioners.

GP – For diagnosis and medical knowledge. Your GP is the first place to go for any diagnosis. If your GP cannot complete a diagnosis he will be able to send you to someone who can. • Physiotherapy – For injury rehabilitation with medical knowledge. A physiotherapist will work generally on a specific site on your body. They may use manipulation techniques and suggest exercise programmes. • Chiropractic – For diagnosis, medical knowledge, injury rehabilitation and chronic pain relief. According to the Collins English Dictionary this is a system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. They use manipulation and movements beyond your normal range. They tend to do this quickly, many people will recognise this as “clicking”. • Osteopathy – For diagnosis, medical knowledge, injury rehabilitation and chronic pain relief. According to the Collins English Dictionary this is a system of healing based on the manipulation of bones or other parts of the body. This is a more holistic approach than chiropractic, but they also use movements beyond your normal range. They tend to do this slowly, manipulating and stretching the muscles and tendons.

Bear in mind that, with the exception of GPs, you might have a very similar treatment from any of the above therapies and differentiation can be quite difficult. They all undertake many years of training in their own discipline and are required to be registered to practice.

2. Exercise Methods:

Yoga – An ancient teaching from India. It is as much a way of life as an exercise class. There are many types. Some will include extreme positions and movements to improve strength and flexibility. Some include meditation, breathing, and relaxation techniques. Some will use flowing movements through a range of positions to achieve strength and flexibility. Try to talk to your yoga teacher prior to attending a class to establish whether the class will suit you. Generally you can expect a Yoga class to be physically challenging and involve a lot of stretches, balances and quiet reflection. • Pilates – Invented in the early 20th century by Joseph Pilates. This concentrates on the development of the “core” musculature. Again there are a number of variations from the pure, following exactly the original moves and approach, to fitness based and hot Pilates. Generally you can expect a Pilates session to be full of small slow movements coupled with balance. The focus is on correct technique to ensure the engagement of the important “core” muscles of the body. • Gym Training – A range of strength and cardio-vascular training equipment can be found in most gyms. Trained staff are on hand to explain the use of the equipment, and you would expect to have a personal programme to follow developed by one of the trainers. The staff are usually fitness experts but may not necessarily have any more specific training or expertise. Generally you can expect to be left to follow your own programme at your own pace in your own way. • Exercise classes – There are a large range of general exercise classes from circuit training to spin, from British Military Fitness (BMF) to Zumba. They are normally quite large classes (8 to 30 and more) and can be very social. There is usually a large cardio element to these classes, some also include strength work. You can expect to work hard, work up a sweat, and gain stamina. • Personal training – Otherwise known as one-to-one or consultancy. This category covers a wide range of services from specific sport training, through weight loss and life coaching, to back care and post-operative exercise. Some personal trainers are also qualified in massage techniques and a one-to-one session can help enormously to get the best out of classes such as yoga and Pilates. You can expect personal and tailored interaction but make sure you understand the qualifications of your trainer and that they match your goals. These one-to-one sessions are usually invaluable in helping people to meet their goals by selecting the best therapies and explaining the important techniques.

Once again it is a good idea to discover what qualifications and experience your trainer has, for any of these exercise therapies. Do remember that an inexperienced therapist can be just right for you, and an experienced, well qualified therapist may not suit your requirements. That situation is rare, it would be more normal for you to get a fuller, more effective and more enjoyable class from a more qualified and experienced instructor. In other words, to some extent, you will need to “suck it and see”. Just because you went to a Pilates class and it made your back hurt, that doesn’t mean that all Pilates classes would make your back hurt.

3. Massage Therapy (soft tissue therapies).

Sports Massage – Despite its name this is not just for fit and active people. It is a deep massaging technique that focuses on areas of tight or knotted muscles and aims to release them by manipulation and the use of pressure. It can be quite painful, and often the massaged areas can be worse for a couple of days. Generally there is noticeable improvement after that. Having said that, very often it is not painful, and the improvement can be immediate. It is unlikely to be a relaxing experience although some people do find it so. Look for a sports massage if you have muscles that are knotted. Deep massage can encourage a healthy circulation before strenuous activity and a sports massage therapist can also provide post exercise or event massage. • Myofascial Release – Your whole body is covered with the fascia. It is under the skin, but over the muscles. If you look at a joint of meat the fascia is the white fibrous covering. In the best circumstances the fascia is taut yet flexible. In most people it has areas where it is attached to muscles, or damaged, or affected by scar tissue and so on. It can be like having a large rubber band holding your body out of alignment. As a result you may have pain in a shoulder that is cause by tight fascia running down your leg. A Myofascial massage is different from any other soft tissue therapy and feels gentle. The aim is to free the fascia to allow the body to align itself correctly. Look for a fascial release massage to ease those aches and pains, or to correct a postural anomaly. • Manual Lymphatic Drainage – Generally known as MLD. The body’s lymph system is just as important as the blood system, although not many people realise just how essential it is. Without lymph your blood would not get oxygen from the lungs, and your muscles would not get the oxygen from the blood. Not only that, but the body’s immune system would not work at all properly. It is lymph that is normally responsible for swelling at injury sites. Lymph is circulated around the body, but it doesn’t have pipes and a pump like blood, it relies on muscle movement and gravity to get around. There are specific sites around the body that process lymph, called lymph nodes. It is here that the lymph is processed to allow it to fulfil its many functions. The movement of lymph around the body can be adversely affected by inactivity, injury, illness and pressure. You should consider MLD if you have swelling, such as post joint replacement surgery, joint pain, or sinusitis. Since the lymph system is in the skin MLD is extremely gentle, but its effects can be immediate and dramatic. • Swedish Massage – Probably the best known massage. There are a wide range of generic massage techniques, such as this, that have general positive effects, but are not targeted like the techniques covered so far. They range from light to deep massages, some involve slapping and or drumming actions, others are done with the feet. Swedish massage will stimulate the circulation and be both enjoyable and very relaxing. • Hot Stone Massage – The use of pre-heated stones helps in many ways to increase the effect of massage. Hot stone massages are extremely relaxing. The heat from the stones encourages circulation and the muscles to relax. Using a hot stone to massage with has the effect of a deep massage without the need for so much pressure. Try one of these if you are stressed, or if you have any particularly stiff or knotted muscles. • Indian Head Massage – Although it is called a head massage you will normally get a head, face, neck and shoulder massage. It is said to stimulate hair growth, but it is definitely a most relaxing massage. It can be done with the client in a sitting position, and fully clothed, so it is ideal for an office environment, or anywhere away from a massage couch. When I have given these types of massage it is quite normal for my client to fall asleep, such is the relaxing effect of the technique. It is very good at reliving the tension in the shoulders that results from sitting at a desk working a computer. Try one of these if you are stressed, have a stiff neck, have a head ache or just fancy a good old pampering.

Which massage may suit you is very difficult to identify, a particular massage for one person can be brilliant, the same massage for another person can be debilitating. Have a conversation with your chosen therapist about your own preferences and any medical conditions you may have. If you have a bad reaction after a massage it is worth letting the therapist know and going back for another try. Most qualified soft tissue therapists will have a range of techniques at their command and will be able to take an alternative approach to avoid any bad reactions.

4 Other specialist areas

Postural Assessment • Therapists with a postural assessment qualification will be able to identify any postural issues that may be causing pain, or imbalance. They will have a thorough knowledge of the musculature that is essential to correct stance. This is applicable to both exercise and massage therapists.Bio-MechanicsThis area is a whole profession in its own right. Usually employed to gain the maximum performance from athletes and sports people, it has an application for everyone. A therapist with bio-mechanics training will be able to help anyone to a better understanding of their body and, generally, to identify an alternative approach to solving issues such as back pain, knee pain and the correction of running or walking style (gait).GP ReferralThis qualification enables exercise therapists to understand and make allowances for chronic conditions presented to GPs which would benefit from exercise. A therapist with this knowledge can support not just GPs, but any of the medical therapists (osteopaths, chiropractors and physiotherapists). Often this support can be in the form of specific exercise plans, but may also be particular massage techniques.Back PainThe causes of back pain are myriad. Sometimes there is a medically identifiable issue (e.g. herniated disc), but often there is no specific reason for the pain. Where this is the case therapists with specific training in dealing with back pain are able to help with targeted exercise plans, manipulations and massage.

In short, look at the qualifications of your chosen therapist and make sure that they meet your requirements.Remember that you can get a good result from a newly qualified therapist, but if you have a recurrent problem to solve, look for qualifications, experience and evidence of on-going training, as research continues to improve the way we treat physical conditions.

Pilates, Yoga and back pain.

What is the difference between Pilates and Yoga, and why would you choose to take up one or the other?Frequently either are recommended by physio’s or doctors for back pain and can be very beneficial under the right circumstances. Unfortunately both carry inherent risks, particularly for people with back issues, and Yoga tends to be less useful than Pilates in these circumstances.

YogaYoga was developed in India hundreds of years ago to address a whole range of human issues, from the physical to the psychological. It would normally include a significant spiritual aspect as well as extreme body positioning, providing a 'whole body' (holistic) teaching and healing.More recently popular Bikram and Ashtanga developments of this teaching include a dynamic approach, which can be difficult for less able (normal) people to handle.Many Yoga teachings, including the Bikram and Ashtanga methods, aim to stretch the body as far as possible and to target the maximum range of movement through each joint. While this may be considered beneficial for a person with no history of joint pain or injury, it is not recommended from a bio-mechanical view. One reputable source recommended that only the under 25’s should be allowed into this type of yoga class.I feel it is not developed from a physiology base, and not all positions nor movements would be recommended by up to date research into human physiology.There are Yoga classes that focus on the spiritual elements and relaxation. These can be perfect if you are looking for stress relief or a meditation like class. The spiritual element actually enables some people to really connect their mind and body and gain a tangible benefit from this.

PilatesPilates is an exercise method developed by Joseph Pilates, an injured gymnast and body builder, in the 1920's. It was developed from exercises from all the programmes available at the time along with some innovation from Joseph P. This included Yoga and several fundamental Pilates exercises clearly come from this discipline. Joseph understood the need for “core strength” and this is the focus for most Pilates forms.Whilst there are still trainers that teach “pure” Pilates (as Joseph would have done), other professionals have modified and developed the exercises ever since. There is no copyright on the word 'Pilates' so the content of classes can vary hugely.

Back PainMany of the Yoga movements are medically contra-indicated for the back (i.e. the risk of making matters worse, by doing the exercise, is greater than the likely benefit). Some of the Pilates movements are also contra-indicated for the back (mostly derived from Yoga movements).For an example of a Yoga inspired Pilates exercise which can cause back pain we can take a bio-mechanical look at the ‘roll down’.Yoga and Pilates both use the ‘roll down’, a movement from sitting to lying where the back curls round to allow vertebra by vertebra to reach the floor. The intention being to strengthen the abdominal muscles.But what actually happens to your body when doing this?The intervertebral disc space is opened which can aggravate or even cause bulging (herniation/slipped disc). A little like squeezing a jam donut until the jam pops out.In fact not only the abdominal muscles but also the hip flexors, hold the body as it rolls down.The shoulders curl forward shortening the pectoral muscle group and the mid trapezius lengthens.For many people these muscles are either already tight (pectorals) or already long (mid trapezius) from daily repetitive movements such as computer work or driving. The hip flexors are frequently tight just from sitting down for too long.It turns out that this exercise provides no real benefit but potentially compounds the postural issues that everyday life gives most of us. Worse still it can aggravate back pain and intervertebral disc issues, rather than helping.

My training as a back pain specialist made me question the validity of some of these exercises, particularly when clients have back problems (slipped or bulging vertebral discs, degeneration of facet joints or osteoporosis). My bio-mechanic training has encouraged me to question each exercise that I teach. What is the benefit? What is the risk? Why am I teaching it to this particular group? Is there a better way to gain the desired result? There should always be a clear answer to all these questions.I have been teaching Pilates and Yoga, in various forms, for more than 20 years. Over the last 10 years I have developed “I move freely” Pilates as an exercise form that carries most of the Pilates benefits with few of the risks.I Move Freely Pilates takes the principles of Pilates but integrates Bio Mechanic coaching techniques to offer an up to date way of keeping mobile, strong and with the optimum amount of flexibility. Mobility work is essential to keep the whole body moving easily. I feel that mobility and balance are key skills that deteriorate with age but which with work can be improved reducing the risk of stiff joints and falls in old age.The strengthening work uses the body's ability to statically contract or 'engage' a muscle as well as using controlled lengthening and contracting of specific muscle groups. It works on the muscles of the abdomen, buttocks (glutes) and back, many of which you can't see (most people don’t even know they have them), but which should perform functional roles of support throughout daily life. It is this functional supporting role that reduces back and other joint pain. Each exercise involves a very precise movement and often it is impossible for anyone else to 'see' how hard a person is working as the work is in 'engaging' a specific muscle. This often leads people to do the exercises at a level below that of which they are capable and so they don't achieve the full benefit but feel they are 'stretching out' rather than 'working'.Performed correctly Pilates can achieve great core stability and it is as useful to elite sportsmen and women as it is to the general public. This link (from my Norfolk Studio) explains more about stretching v working a muscle:http://thestudionorfolk.wordpress.com/2013/08/12/are-you-stretching-or-working-your-muscles/

To ConcludeMost Yoga teachers have spent time in India studying and practicing so they are expert in their knowledge. Most Pilates instructors have studied the teachings of Joseph Pilates and have an in depth knowledge of the exercises and breathing techniques he espoused. However this does not make any of them experts in back pain management. They are unlikely to have had the training to working with particular conditions, such as arthritis, or liaising with physio’s as to the correct exercise programme for someone with a recently herniated (slipped) disc. For this you need a back pain specialist.All forms of Pilates and Yoga can offer some people real benefits. To choose which would suit you best give some thought to what you hope to achieve and how your body will respond to the challenges of each class. Do try several before deciding which suits you and don’t be put off if your back aches after one class, try another – they are all different.I also strongly recommend taking at least one consultation with a back pain trained exercise professional, since it is essential to know some basic information about how to perform Pilates exercises that is not usually covered in the class situation.

Can you keep your waistline and still enjoy Christmas?

Christmas is associated with family, friends and too much food, frequently washed down with too much alcohol.Christmas snacks appear at every gathering and they are usually high calorie, high fat foods.Most people can't avoid eating and drinking more than they should at Christmas, but it is worth giving some thought to the effect on your body if you are to arrive in the New Year with your November waistline intact.

The two simple truths about weight gain:1. Ghrelin & Leptin Your body has hormones which control your appetite but these can become less effective if you consistently over-eat, leading you to eat much more than you need, and hence, put on weight. So, for many people, a party season from early December through to the New Year can upset the hormone system and the kick start the body into a spiral of weight gain. 2. The Energy Equation: Your body is a machine so energy in must equal energy out. Food constitutes fuel, or the energy in. Heat, movement, and the laying down of fat make up the energy out. If the fuel isn't used for heat or moving about, it will be stored for future use. In most adults this storage is as fat. The long-term effect of over indulgingThe whole process of how the body deals with food intake is complex. Hunger is controlled by at least two hormones, one that makes you feel hungry, and another that makes you feel replete. The levels of these hormones in your bloodstream are controlled by many factors but a period of overeating can permanently upset their effectiveness, leaving you hungry when you return to your usual eating habit. If you indulge this hunger then weight gain will result.

Emotional driversAnother factor is your emotional state. Being stressed, upset, happy, bored or depressed will often drive people to eat, and Christmas frequently encompasses many of these emotions. Once eating is associated with emotion the risk of weight gain is higher in the future.

So, how much food do you need?There is an amount of energy that your body needs just to maintain life. This is called BMR. Everyone has a different BMR, and recent research seems to show that being fit has little effect on your BMR. The average number of Calories the body needs just to exist is about 1800. Added to this is your energy usage which varies according to your level of daily activity.Bear in mind that a typical Christmas day food intake can easily be 5000 Calories.In this week’s news the worlds fattest man passed away, he was eating 20,000 Calories a day! It’s a huge amount but easily possible.

Your Christmas coping strategy • Check the Calorie content of party foods that you buy or prepare. • Don't have that second mince pie or piece of cake. • Use the same size portions as normal for all meals. • Have some days of abstention in with the feasting - remember the 5\2 eating plan, it really does work. • Take some exercise. Get out of the house for some fresh air, a walk, cycle or swim – this can have multiple benefits: getting some exercise (using more Calories), less opportunity to eat and some stress busting effect. Add to that the fact that being out in the cold burns more calories and it’s a ‘win win’ activity. • Remember that the food groups that have the most calories per weight are fat and alcohol! That bottle of wine or beer or the odd quaff of brandy etc. is very likely to end up being stored as fat - the saying 'a moment on the lips, a life time on the hips' really does reflect the truth. • Try to stay calm, accept family situations and give yourself some 'chill time'. • Make sure you get enough sleep over the holiday period. Lack of sleep disturbs your hormone balance, this will result in you feeling hungry when you don’t need the food, hence weight gain.

It would be pointless to suggest being abstemious over Christmas, but if you can curtail the excesses to some extent, take more exercise, get out of the house from time to time and have the odd day of rest from the food and drink, then you will be healthier, feel better and not spend January on yet another diet.

5 Adaptations your exercise plan needs once you are over 50

As your body ages, exercise is essential to keep it functioning at its best for the whole of your life, keeping you active into old age. The problem is that as your body ages it becomes less able to handle rigorous exercise, more prone to injury and less able to recover. The good news is that with a few modifications you can continue to exercise whatever your age.

Age is 'just a number' so it's difficult to be precise about when to start modifying your exercise programme to take account of the aging process. Bear in mind that, for example, most people over the age of 40 will show some degeneration in the spine. With a few key adaptations you can reduce the risk of injury and achieve an effective workout to keep you 'fit for life for all of your life'.

Longer warm up Age related changes are seen in all tissues. The heart and cardiovascular system is no exception. The heart cannot pump as efficiently, the maximum heart rate is slower and it recovers more slowly. Take account of this by warming up for longer, reducing the intensity of your exercise, monitoring your heart rate and allow a longer cooling down period.

Steps to avoid crampNo one knows the details of what causes cramp, but we do know scenarios which will affect the likelihood of cramp. Cramp has a variety of causes for all people including being new to exercise. Older people have a reduced tolerance to muscle fatigue and associated blood acidity which leads to cramp. More effort is needed to achieve movement due to the decrease in amount of muscle tissue. This leads to an increase in levels of lactic acid which can cause cramp. Compounding this effect is the fact that the body is less able to tolerate acidity as it get older. Cramp is also linked to dehydration. The body holds less water as it ages making cramp more likely. Ensure you drink plenty of water.

More specific joint mobilisationAge related changes show within the joints with less synovial fluid being released as well as the fluid becoming less effective in lubricating the joints. Joint mobilisation can encourage the release of the synovial fluid and this is essential prior to exercise so the joints move more easily.

Focus on deeper breathingWhile our lungs remain able to hold the same amount of air on each breath throughout our lives the amount of air that we breathe in and out on a regular breath cycle decreases. This effects the level of oxygen in our blood and therefore our ability to exercise. It's important to take deep breaths to increase the available oxygen which enters the lungs on each inhalation. Start off with a few deep inhalations and include them in your cool down too to speed up recovery.

Less extreme movementChanges occur in the cartilage and connective tissues of all joints reducing the range of movement and causing stiffness, especially in the mornings. As the cartilage thins between the intervertebral discs in the spine its shock absorbing ability is reduced. This will have an effect if you take part in high impact exercise such as running. Less elasticity within connective tissue make movements such as sitting cross legged more difficult. Movements to avoid include: those which move any joint beyond normal range, those with extreme flexion (leaning forward) and extension (leaning back) and using poor posture particularly when carrying heavy weight.

Follow theses simple adaptations and you'll be fit for life for all of your life. I strongly advise a one to one session before joining a class and ensure that the class you join is taught by a suitably qualified instructor.Qualifications to look for:GP Referral for exercising with specific conditionsAdapting exercise for older adults

Should you exercise when you are stiff or sore?

Should you exercise when your back or any other joint is sore or stiff?This is a question that I am often asked so I thought I would document my advice about this.

I will explain why I believe the answer is usually yes you should, but only with qualified supervision and, sometimes, the knowledge of your doctor.

Firstly you should never do anything that is going to aggravate any condition from which you may be suffering. So for any pain it is important to obtain a medical diagnosis of the cause. Once the cause is understood, or is at least known not to be a condition which would be exacerbated by movement, then controlled, prescribed exercise will help. Conditions which do need rest are broken bones, torn ligaments or muscles and severe bruising.

So, your diagnosis does not preclude exercise, you've not broken a bone, bruised soft tissue or damaged a ligament. But you are in pain, should you be exercising, and if so what should you do and what should you avoid?

If you are suffering pain, then don't exercise alone, always do it under the supervision of a qualified instructor, at least for the first few sessions. No, I am not just drumming up business for people like me, if your exercises are to be beneficial it is vital that you are engaging the correct muscles and making the appropriate movements. Once you and your instructor are happy that you know what you are aiming for, then it is not necessary to have supervision all the time. Even then, it is advisable to get a session from time to time to check you have not slipped back in to "bad habits".

Generally warm up exercises help to keep joints mobile. There are some specific exercises that will stimulate the release of synovial fluid into the joint capsule. This will help the joint to move more easily.

It is important to "listen" to your body. There is 'good pain' and 'bad pain'. Most people know whether a pain is to be ignored and worked through (good pain), or is telling you to stop doing what you are doing (bad pain). Often it is an indicator that you are not performing an exercise in the correct way, or sometimes that an alternative exercise is needed to protect and strengthen weaker areas. Whatever, don't just suffer silently, talk to your instructor who, with your help, should be able to work out how to improve the situation.

If you have Rheumatoid Arthritis you need to take more care. If your joints are hot and sore (in flare up) it is best to rest the affected area. But it is important to keep as much the rest of your body as mobile as possible. This is normally easily achieved with the use of static exercises and carefully choreographed dynamic exercises, avoiding the joint (or joints) in flare up.

If you have 'pulled your back', and there is no damage to discs, vertebrae or spinal column, there can be a number of muscular factors that are contributing to your pain. For muscular pain, exercise can help to loosen the affected area. Movements should be slow and small to encourage tightened muscles to release and this will, in turn, relieve the pain. You might also benefit from some releasing massage. Once the pain has subsided then slightly more rigorous, but still controlled, exercises should be performed to gradually improve the strength and suppleness of the supporting muscles.

For arthritis in the spine, gentle exercise will help to keep the spine moving. It may not relieve the pain completely but it will enable you to keep as much movement as possible. Again, increased support from toned muscles can provide a level of relief.

Another common condition I see is scoliosis. It seems that once combined with the aging process scoliosis does give more pain. If you find that you are stooping more this could be the combination of your scoliosis with osteoporosis or degeneration of the spine. In this case exercise may be painful as muscles are encouraged to bring you into a more upright position while the bones are degenerating and the scoliosis worsening. There is a balance to be found using small specific exercises which will help while avoiding many mainstream exercises which while helpful will cause more pain than is necessary.

Please note that if, with your back pain, you have any loss of feeling into your legs or any additional symptoms (such as loss of bladder control) I would suggest that you contact your doctor with some urgency, for further advice.

In general, if you have joint pain exercise helps to strengthen the muscles that support the joint. This is particularly effective for knee and hip joints. You should be aware that the "pure" forms of both Pilates and Yoga can put unnecessary stress or loading onto joints, particularly the back, hips, shoulders and knees. Seek out an instructor qualified in GP referral, or exercise for the older person who can modify a class to use only the exercises that encourage good muscle engagement. These are normally those with smaller movements that will minimise wear on the joint while maximizing the benefit.

If your pain makes it difficult to get down on to the floor, you might be able to lie on a couch. Or, if you can get to the floor, but find it uncomfortable once there, ask your instructor for a softer mat, cushions and/or blankets to enable you to get comfortable. Use of these accessories is not detrimental to your exercise, and you might as well be comfortable.

In summary, the correct form of exercise is almost always beneficial. So, yes you should exercise, but carefully and under the guidance of an expert and with the knowledge of your doctor.